ReACT Conference Identifies Challenges and Actions to Tackle AMR in Africa
 

The Action on Antibiotic Resistance (ReAct) Africa has published a report of its Annual Conference held in Nairobi, Kenya in September. The conference brought together participants from 14 African countries, India and Sweden, to share experiences and updates on the progress that African countries have made in developing and implementing AMR National Action Plans.   ReACT is a leading scientific and advocacy organisation that has championed the fight against AMR for many years; it is headquartered in Sweden and has a global outreach. 
 
The theme for the conference was 'Moving beyond the development of National Action Plans on Antimicrobial Resistance to implementation'. Conference participants came from government Ministries (especially Health and Agriculture), NGOs and academia. The countries represented included Ethiopia, Ghana, Kenya, Malawi, Mozambique, Nigeria, South Africa, Uganda, Zambia, Cameroon, Liberia, Rwanda, Zimbabwe.
 
Below is a section of the report, which is on key outcomes and recommendations on national action plans as well as issues relating to awareness raising, surveillance, stewardship, research and development, and monitoring and evaluation.
 
To access the full report, visit
https://www.reactgroup.org/wp-content/uploads/2017/10/RAN_Conference-2017-Report.pdf
 

EXTRACT FROM REPORT OF ReACT AFRICA CONFERENCE (SEPT. 2017)
 
Frameworks:

• National Action Plans require collaborative efforts with involvement of all relevant stakeholders across human, animal, agriculture and environmental sectors in the process of development. Failure to do this pose challenges for the buy in needed for implementation. This process of NAP development should be government led, as the NAP is ultimately a government document and commitment. Where a relevant AMR Policy instrument will be needed to facilitate and enable implementation, it should be developed at the same time.

• NAP implementation is resource intensive beyond what African countries are able to afford or invest and will require the global community to find ways of supporting through different initiatives that might include setting up a Conservation Fund and involvement of HICs and multilateral partners.

• Some countries may need to develop an AMR policy and a legal framework that will support implementation. Failure to do this might result in many activities and strategies failing to be implemented. It is important to consider and check country specific legal structures.

• Current National Agendas include running activities and projects focused on achieving SDG goals. AMR activities can be streamlined, mainstreamed and included in already existing country efforts on SDGs as a way of getting more value from these projects but also as one mechanism of gaining political will and mobilising funds at the national level.

• Maintaining the integrity of the implementation process outside of political influences is critical and allows for objective monitoring and evaluation.

• Strengthening regulatory frameworks that include enforcement should be not be excluded. Finally, explore targeted incentives, unique to these sectors, to conjure change behavior.

Raising Awareness:

• Raise awareness on AMR through culturally-sensitive public campaigns that "put a face" to AMR and address behaviour change i.e. a mix of traditional media and an exploration of innovative synergies with e.g. faith-based organizations, local celebrities etc.

• Target various stakeholders, including farmers, feed-millers, veterinary practitioners, doctors, prescribers, pharmacists, policy makers and consumers.

• Form a network across countries (regionally is possible) of AMR focal point persons as a "support group" that shares experiences at various stages of the implementation stage.

Surveillance:

• Surveillance for AMU and AMR at all levels of One-Health paradigm in local and National settings should be adopted and implemented.

• Surveillance networks at different levels of healthcare system should be coordinated through one agency or department.

• Strengthening laboratory capacities, standards, policies, infrastructure and equipment.

• Perform an objective evaluation that grades the functionality and comprehensiveness of the current Surveillance Programs in place. A few countries like Kenya, South Africa, Zambia, Malawi, and Ghana have however joined the Global AMR Surveillance System (GLASS).

• Map and consult academic institutions with research capacities and explore how they could be involved in surveillance across sectors.

• Continuous surveillance to understand both available products on the market and consumption data should be routine.

• AMR containment and surveillance efforts should include quality if antimicrobials.

• Post marketing surveillance of antibiotics is especially important to assure the quality of products beyond registration. Any failures should be communicated not only nationally but regionally and to the WHO Quality Assurance Program.

Antimicrobial Stewardship:

• Beyond setting up AMS programs, coordination of these programs across sectors will be vital.

• Improve antibiotic stewardship through empowering and educating key-point persons at decentralized-government institutions, hospitals and lower-level stakeholders such as community workers, healthcare workers, retail-pharmacists, public health officers in other disciplines and technicians.

• Mainstream AMR Stewardship (AMS) committees within existing stewardship committees e.g. Medicines and Therapeutic Committees (MTC) avoiding creation of new structures and spreading thin the same staff to sit on these committees.

Infection, Prevention, and Control:

• Dedicate a focal point person that continuously monitors adherence to guidelines as an Infection Preventative Measure (IPC) program.

• Integrate IPC to include AMR in more established existing preventive programs such as HIV, Tuberculosis, and Malaria.

• Develop IPC programs to be implemented in the animal, environment and agriculture sectors beyond the human sector and collect actionable data that promote good IPC practices. IPC programs are not common in the non-human sector and most NAPs do not contain such an IPC module.

Research & Development:

• Deepen collaboration among continent-based R&D laboratories and global research efforts on new antibiotics, vaccines and diagnostics as well as innovation of practice in tackling ABR. Research to include the potential alternatives to antibiotics such as probiotics, traditional medicines etc.

• Adherence to the government agreed principles that relate to R&D as outlined in the UNGA Declaration should form a basis of all R&D initiatives including promoting delinkage models.

• Capitalize on the current projections of the growth of the pharmaceutical industry in Africa, projected to be a 40 US billion industry by 20300. African governments will need to invest in R&D and engage in global discussion on R&D to ensure that that African public health priorities and needs are addressed.

• National Action Plans need to highlight and focus on ensuring the quality of antimicrobials through promotion and adherence to GMPs. Action priorities here include: Improving transport and storage of legitimate medicines, promoting verifiable GMP among registered products, tackling the production of falsified and substandard products, strengthen regulatory authorities, and ensure regulatory transparency, increase awareness on the topic with policy makers and the public.

• Cost AMR interventions and programs to accurately develop an economic case for AMR containment to policy makers at national level as well as with international development funders.

Monitoring and Evaluation:

• Monitoring and Evaluation should cut across all strategic areas of the GAP adapted in the NAPs. Indicators should be carefully selected, communicated and allow for comparison within the country, region and globally and in line with WHO, OIE and FAO recommendations. They should equally foster accountability.

• There are a number of programs running under the SDG agenda with indicators already. The existing indicators should be taken into consideration and integrated where applicable in the NAP M&E Framework.